Coral calcium + L-Methyl Folate Calcium + Methylcobalamin + Vitamin D3

Usage

This combination medication is used to address nutritional deficiencies related to calcium, vitamin D3, methylcobalamin (vitamin B12), and L-methylfolate (vitamin B9). It is prescribed for conditions like:

• Osteoporosis
• Osteomalacia
• Rickets
• Hypocalcemia
• Megaloblastic anemia (due to B12 or folate deficiency)
• Conditions with impaired nutrient absorption

It is also beneficial for pregnant or breastfeeding women, the elderly, those with lactose intolerance, and individuals following vegan diets.

Pharmacological Classification: This is a combination product. Individual components classify as:

• Calcium carbonate/Coral Calcium: Mineral supplement
• Vitamin D3: Fat-soluble vitamin supplement
• Methylcobalamin: Water-soluble vitamin (B12) supplement
• L-Methylfolate: Water-soluble vitamin (B9) supplement

Mechanism of Action:

• Calcium: Essential for bone health, nerve function, muscle contraction, and blood clotting.
• Vitamin D3: Improves calcium absorption from the gut and regulates calcium/phosphorus metabolism.
• Methylcobalamin: Crucial for nerve cell maintenance, red blood cell formation, and DNA synthesis.
• L-Methylfolate: Essential for cell growth/division, especially during pregnancy for neural tube development. It’s the active form of folate, readily used by the body.

Alternate Names

Ekocal; Cal 123 Total; Vehycal Xt; Tricium Active; Tayo Total; Koral Max; Coralife Max; Kapcal; Ostovista Plus; Ostovista Forte. No internationally recognized non-proprietary name exists for this specific combination.

How It Works

Pharmacodynamics:

• Calcium: Supports bone mineralization, neuromuscular transmission, and enzyme activity.
• Vitamin D3: Increases calcium absorption and bone mineralization. It also modulates immune function.
• Methylcobalamin: Coenzyme for various metabolic processes, including DNA synthesis and myelin formation.
• L-Methylfolate: Involved in DNA/RNA synthesis and amino acid metabolism. Crucial for fetal development.

Pharmacokinetics:

• Calcium: Absorbed in the small intestine, influenced by vitamin D. Excreted renally and in feces.
• Vitamin D3: Absorbed in the gut, hydroxylated in the liver and kidney to its active form (calcitriol).
• Methylcobalamin: Absorbed via intrinsic factor in the ileum. Stored in the liver.
• L-Methylfolate: Absorbed in the small intestine. Metabolized in the liver.

Mode of Action: Not applicable to the combination as a whole, but each component has a distinct mode of action as described above.

Receptor binding, enzyme inhibition, neurotransmitter modulation:

• Vitamin D3 binds to vitamin D receptors, influencing gene transcription.
• Methylcobalamin acts as a coenzyme for methionine synthase and methylmalonyl-CoA mutase.
• L-methylfolate is involved in enzymatic reactions for nucleotide synthesis.

Elimination pathways: Primarily renal and fecal for all components, following metabolism in the liver where applicable.

Dosage

Dosage varies depending on individual patient needs and the specific formulation. It is crucial to consult with a physician for personalized dosing recommendations. Below is a general guideline based on over-the-counter formulations and examples, not prescription medications:

Standard Dosage

Adults:

• Calcium: 1000-1300 mg daily.
• Vitamin D3: 200-800 IU daily.
• Methylcobalamin: Dosages vary widely depending on the indication.
• L-Methylfolate: 400-800 mcg daily.

Children: Dosage must be determined by a pediatrician based on age, weight, and specific needs.

Special Cases: Dosages should be adjusted by a physician considering the patient’s condition and comorbidities.

Clinical Use Cases

This combination is not typically used in acute clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. Specific medications are used in those cases based on established protocols.

Dosage Adjustments

Dosages may need adjustments in patients with renal/hepatic impairment or other conditions impacting drug metabolism. This should be determined by a healthcare professional.

Side Effects

Common Side Effects:

• Constipation
• Nausea
• Upset stomach

Rare but Serious Side Effects:

• Hypercalcemia (high calcium levels)

Contraindications

• Hypercalcemia
• Vitamin D toxicity
• Hypersensitivity to any of the components

Drug Interactions

• Antacids can reduce calcium absorption.
• Certain medications (e.g., bisphosphonates, levothyroxine) may interact with calcium.
• Some antibiotics may interact with vitamin D absorption.

Pregnancy and Breastfeeding

Generally considered safe when taken as directed, though excessive intake should be avoided. Consult a healthcare professional for appropriate dosing during pregnancy and breastfeeding.

Drug Profile Summary (See information above)

Popular Combinations

This combination itself is a common one. Sometimes individual B vitamins are given separately at higher doses, depending on the patient’s specific deficiency.

Precautions (See information above)

FAQs (Frequently Asked Questions)

(Please note, more specific dosing recommendations should be obtained from a physician.)

Q1: What is the recommended dosage for Coral calcium + L-Methyl Folate Calcium + Methylcobalamin + Vitamin D3?

A: Consult a physician. Dosages vary considerably based on individual needs and product formulations. General guidelines are as provided above.

Q2: Can this combination be used to treat pernicious anemia?

A: While methylcobalamin is used in pernicious anemia treatment, the other ingredients in this combination are not specifically indicated. Pernicious anemia requires specific treatment approaches determined by a healthcare professional.

Q3: Are there any specific dietary restrictions while taking this combination?

A: It’s best to avoid excessive intake of calcium-rich foods if you are supplementing with calcium. Additionally, certain foods (like those high in oxalates and phytates) can impair calcium absorption.

Q4: Can I take this combination if I have kidney stones?

A: Consult a physician. Calcium supplementation may be contraindicated in individuals with a history of kidney stones.

Q5: Is it safe to take this combination with other multivitamins?

A: Check with a physician or pharmacist to avoid exceeding recommended daily intakes of any vitamins or minerals.

Q6: Are there any specific drug interactions I should be aware of?

A: Yes, potential interactions exist. Inform your doctor about all medications, supplements, and herbal remedies you are using. (See Drug interactions above).

Q7: Can this combination be crushed or chewed?

A: Check product-specific instructions. Some tablets may be crushable or chewable, while others should be swallowed whole.

Q8: How should this medication be stored?

A: Store as directed on the product label. Typically, a cool, dry place away from direct sunlight is recommended.

Q9: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember. If it’s close to the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose.